What is Tendinopathy?
If you’ve been experiencing persistent joint pain that worsens with activity and didn’t start from a specific injury, you might be dealing with tendinopathy. This condition is common in various areas of the body, including:
– Heel: Achilles tendon
– Knee: Above or below the kneecap
– Hip: Gluteal, groin, or hamstrings
– Shoulder: Biceps or rotator cuff
– Elbow: Commonly referred to as golfers or tennis elbow
At Recharge Clinic, we understand how frustrating and debilitating tendinopathy can be. This guide will explain what tendinopathy is and provide you with strategies to reduce pain and get back to the activities you enjoy.
What Are Tendons?
Tendons are robust, fibrous tissues connecting muscles to bones, allowing movement by transmitting the force generated by muscles. They are primarily composed of collagen, which provides strength and flexibility. Healthy tendons adapt slowly to increased loads, a process crucial for maintaining their integrity and function during physical activity.
Understanding Tendinopathy
Tendinopathy is a condition characterized by pain and functional impairment in the tendons, often without visible inflammation. It results from microtrauma that exceeds the tendon’s capacity to heal and adapt. This condition can be caused by:
– Overuse or repetitive strain
– Sudden changes in physical activity
– Poor load management
Common symptoms include pain with activity and tenderness when pressing on the affected tendon.
Managing Tendinopathy
Absolute Rest Is Not Recommended
Contrary to popular belief, complete rest is not beneficial for tendinopathy. Tendons need gradual, controlled loading to adapt and heal. Prolonged rest can lead to deconditioning, making the tendons more susceptible to injury when activity resumes.
Finding an Entry Point
Rehabilitation should be seen as a spectrum rather than a binary choice between rest and activity. The goal is to find a level of exercise that maintains activity without exacerbating symptoms. This often involves scaling back the intensity and volume of exercises and incorporating variations that are more tolerable.
Heavy Slow Resistance Training
The foundation of any tendinopathy rehabilitation program is heavy slow resistance training (HSRT). By “slow,” we mean performing exercises at a controlled tempo, not that the weights are extremely heavy. Typically, this involves a “3-0-3 tempo”:
– Three seconds for the eccentric phase (muscle elongating under a load)
– No pause while changing direction
– Three seconds for the concentric phase (muscle shortening under a load)
Throughout this guide, when we refer to HSRT, we are describing tempo work designed for rehabilitation, not near-maximal efforts. Although most research focuses on patellar and Achilles tendons, the principles can be applied to other areas of the body. The goal is to develop a plan that addresses the affected area with enough load to promote adaptation without exceeding the individual’s tolerance.
In the initial stages of rehab, we recommend performing HSRT two to three times a week at the beginning of your workout. This approach allows you to concentrate on the problem area when you are fresh and can also serve as a warmup, increasing tolerance for subsequent activities. As symptoms decrease, you can move HSRT to the end of the session alongside other accessory exercises. Given that tendons adapt slowly, these exercises should remain part of your program for 12 to 16 weeks.
Here is a common structure for these exercises, though it can vary based on individual needs and symptoms:
– **Weeks 1 – 4:** 4 sets of 10 reps at RPE 8, using a 3-0-3 tempo
– **Weeks 4 – 8:** 3 sets of 10 reps at RPE 8, using a 3-0-0 tempo
– **Weeks 8 – 16:** 3 sets of 10 reps at RPE 8, maintaining a consistent tempo
The aim is to target the symptomatic area while maintaining overall fitness. HSRT might not be completely pain-free initially, and that’s okay. Aim to keep pain intensity below a subjective level of 3 to 4 out of 10. Symptom management is more crucial than achieving high exertion at the beginning.
Below is a list of exercises commonly used in HSRT for rehabilitation. The specific exercises should be chosen based on available equipment and individual tolerance.
Case Studies
Case 1: Over-Specificity
A powerlifter with knee and shoulder pain from repetitive, high-intensity training can benefit from diversifying their exercise routine. Introducing variations like safety bar squats or dumbbell split squats, and reducing the frequency of problematic exercises can help manage symptoms.
Case 2: Dramatic Increase in Exertion
An athlete who increased their training volume too quickly developed elbow and gluteal pain. By incorporating autoregulation, reducing overall intensity, and adding exercise variations, they can manage symptoms and continue training effectively.
Case 3: Too Much, Too Fast
An individual transitioning to half-marathon training experienced Achilles tendon pain due to a rapid increase in running volume. By reducing running frequency, incorporating heavy slow resistance training for the calves, and maintaining cardiovascular fitness through alternative activities, they can manage and reduce symptoms.
Summary
Tendinopathy is a common issue that requires a multifaceted approach to management. At Recharge Clinic, we emphasize the importance of tailored rehabilitation programs that consider individual symptoms, training history, and available resources. If you need help developing a personalized tendinopathy management plan, our expert team is here to assist you. Let’s work together to get you back to the activities you love, stronger and pain-free.
